Use of Intraoperative Fluoroscopy for Brain Ventricular Catheter Insertion: Poor Man's Navigation.

Background: Ventricular catheter (VC) misplacement is one of the most common causes of ventriculoperitoneal (VP) shunt malfunction and revision surgery. Most of the VC placements are done by freehand method. We evaluated the use of intraoperative fluoroscopy for assessing VC placement.

Materials and methods: A total of 70 patients were enrolled in the study. Patients with hydrocephalus who required cerebrospinal fluid diversion were enrolled in the study. Thirty-five patients were placed in the control group (patients in whom intraoperative fluoroscopy was not done), and 35 patients were placed in the test group (patients in whom intraoperative fluoroscopy was done). Patients with trapped ventricles and multiloculated hydrocephalus were excluded from the study. VP shunt insertion was done through standard Keen's point.

Results: The positioning of VC was optimal in 40 patients, with a significant difference between the test group and the control group. Gross malpositioning was seen in seven patients: four in the test group and three in the control group. All gross malpositioned VCs in the test group were corrected intraoperatively. VC crossing midline was less in the test group as compared to the control group.

Conclusion: Fluoroscopy is an easy and cheap method to assess VC position intraoperatively. It is readily available and helps us in avoiding resurgery due to VC misplacement and subsequent blockage.